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RESEARCH PRODUCT
Phylogenetic analysis in the clinical risk management of an outbreak of hepatitis C virus infection among transfused thalassaemia patients in Italy
Stefania GrimaudoFrancesca Ceccherini-silbersteinLavinia FabeniV. Di MarcoMarianna AragriF. Di RaimondoClaudia MarottaMazzucco WFabrizio BronteMaurizio MacalusoFrancesco VitaleV. Chiara Di MaioDonatella FerraroRosaria Maria Pipitonesubject
SofosbuvirClinical risk management Hepatitis C virus (HCV) Molecular epidemiology Nosocomial outbreak Phylogenetic analysis Antiviral Agents Bayes Theorem Disease Outbreaks Genotype Hepacivirus Humans Italy Phylogeny Risk Management Hepatitis C ThalassemiaHepacivirusHepacivirus030501 epidemiologySettore MED/42 - Igiene Generale E Applicatamedicine.disease_causeDisease OutbreaksSettore MED/07chemistry.chemical_compoundSettore BIO/13 - Biologia ApplicataEpidemiologyMedicinePhylogenySettore MED/12 - Gastroenterologia0303 health sciencesClinical risk managementPhylogenetic analysisbiologyTransmission (medicine)virus diseasesGeneral MedicineHepatitis CHepatitis C virus (HCV)Hepatitis CInfectious DiseasesItalyMolecular epidemiologyThalassemia0305 other medical sciencemedicine.drugMicrobiology (medical)Ledipasvirmedicine.medical_specialtyGenotypeHepatitis C virusAntiviral Agents03 medical and health sciencesPhylogenetic analysiInternal medicineHumansRisk Management030306 microbiologybusiness.industryNosocomial outbreakBayes Theorembiology.organism_classificationmedicine.diseasedigestive system diseasesChronic infectionchemistrybusinessdescription
Background: Occurrence of hepatitis C virus (HCV) infection is reduced by effective risk management procedures, but patient-to-patient transmission continues to be reported in healthcare settings. Aim: To report the use of phylogenetic analysis in the clinical risk management of an HCV outbreak among 128 thalassaemia outpatients followed at a thalassaemia centre of an Italian hospital. Methods: Epidemiological investigation and root-cause analysis were performed. All patients with acute hepatitis and known chronic infection were tested for HCV RNA, HCV genotyping, and NS3, NS5A, and NS5B HCV genomic region sequencing. To identify transmission clusters, phylogenetic trees were built for each gene employing Bayesian methods. Findings: All patients with acute hepatitis were infected with HCV genotype 1b. Root-cause analysis, including a lookback procedure, excluded blood donors as the source of HCV transmission. The phylogenetic analysis, conducted on seven patients with acute infection and eight patients with chronic infection, highlighted four transmission clusters including at least one patient with chronic and one patient with acute HCV infection. All patients in the same cluster received a blood transfusion during the same day. Two patients with acute hepatitis spontaneously cleared HCV within four weeks and nine patients received ledipasvir plus sofosbuvir for six weeks, all achieving a sustained virological response. Conclusion: Combined use of root-cause analysis and molecular epidemiology was effective in ascertaining the origin of the HCV outbreak. Antiviral therapy avoided the chronic progression of the infection and further spread in care units and in the family environment.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-09-01 |